Got a copy of my report- Still gonna get a second opinion

[beespin]

Hello everyone that has been kind enough to reply to my first post and help me with some great advice. As you all know, I've been working on trying to understand my condition a little clearer. I was diagnosed with moderate MVP/MR in mid-March. After an echo, stress test, and TEE/bubble tests, this is the info on my report. If you can help me understand it a little better, that would be much appreciated.

1. Left ventricular ejection fraction was greater than 55%.
2. shaggy-looking mitral valve leaflets with anterior mitral valve prolapse. There is moderate MR.
3. Slight thickening of the tricuspid valve leaflets with trace of TR.
4. Trace of PI.
5. RVSP is normal.

Left Ventricle:
The left ventricle is normal in size. There is normal left ventricular wall thickness. Ejection fraction = >55%.

Right Ventricle:
The right ventricle is normal in size and function.

Atria:
The left atrial size is normal. Right atrial size is normal.

Mitral Valve:
Shaggy-looking mitral valve leaflets. Prolapse of the anterior mitral leaflet. There is moderate mitral regurgitation.

Tricuspid Valve:
Slight thickening of the tricuspid valve leaflets. There is trace tricuspid regurgitation. Right ventricular systolic pressure is normal.

Aortic Valve:
The aortic valve is normal in structure and function. No aortic regurgitation is present. Trace pulmonic valvular regurgitation.

Great Vessels:
The aortic root is normal size.

Pericardium/Pleural:
The pericardium appears normal.

After that Summary, there is a list of measurements and calculations that are extremely confusing. The only measurement that is 'familiar' reads:
MR max vel: 420 cm/s

After my visit, the cardio couldnt tell me if I would be looking at repair or replacement in my future. She did, however, make it clear that I could at anytime experience Congenital Heart Failure which could lead to pretty immediate surgery. With that being said, she advised me to have children NOW (if they were in my future), since after surgery I couldnt even consider a pregnancy. Let me know what you think, and if you're able to explain any of the findings, I would appreciate that as well. Thanks again everyone.

 

[Herb_Webb]

I was in full congestive heart failure when I had my mitral valve replaced. You are the perfect place in your life to make changes and choices to avoid what I did not.

At the risk of being challenged by Bryan again. I would suggest doing more research into causes. There is a medical Dr who is challenging the drug influenced medical community with natural methods to good health. Her name is Dr Sherry Rogers. Her books inlcude "Is your Cardiologist Killing you" and "The High Blood Pressure Hoax" both of which I believe to be excellent. She supports her claims and recommendations with research from many top medical journals and publications. Research she quotes is not from the shade tree or third world. Often she references studies by the Mayo Clinic and Harvard. Amazingly some of those studies are ignored by the institutions where they were done. Anyway my opinion for what its worth is that check out nutritional deficiencies, toxins, other problems like underlying GI bugs and viruses.

I got off of blood pressure medications by changing my diet and losing weight. I also reduced my tachycardia and got off of beta blockers (temporarily) too. I was on the BP meds for 11 years and the betas for 6 months and was able to get off them 2 and 3 months after those changes. My Atrial flutter has not left entirely and I am on different meds (I do not totally ignore Doctors) but it has reduced noticeably since adding Magnesium supplements and cod liver oil. BTW research shows that the majority of Americans are magnesium deficient and Mg is an active element in close to 300 functions within the body.

Best of luck in your search for health.
Herb

 

[ejc61]

Hello Beespin,

I'm not a doctor.

In my case, I had MVP with severe regurg. No sympthoms, no other issues. My EF was pretty normal, aortic valve regurg min to mild and not a concern at the moment. My left atrium got to about 6.2. The other chambers were pretty normal. I'm told when the left atrium reachs 6.0, that surgery is thought about. The TEE confirmed that the MV had a tear of some sort.
The cardiologist will not be able to tell you if they can repair or replace since he's really not a surgeon. My opinion is that he needs to advise you on whether surgery needs to be considered. Back in the old days, they would not do a surgery or at least hesitate to fix a mitral valve only because a strenotomy is really too invasive. So they would try to treat it with meds until other things broke down making the sternotomy more justifiable. Today, they can repair or replace the MV with minimally invasive techniques in the absence of other issues. You will have to have a heart cath and maybe a CT Scan of some sort to see how your system is working. This is how it was explained to me by my cardiologist.
I think a second opinion is a good idea. I didn't find it, but are you sympthomatic? Short of breath for example?

 

[beespin]

Thanks for replying ejc61-
I am sympthomatic (I think). And the reason why I said 'I think' is because the cardiologist I've been seeing doesn't think my symptoms are all that much to worry about. I get easily fatigued, random palpitations, shortness of breath when I lie down, chest pain (what feels like directly in my heart), and occasional migraine headaches. Although I've told the cardio about what I've been feeling, and my leakage is moderate, she still continues to tell me I'm not in dire need of medication or surgery. I understand that my heart may not be at the severe state, but I tend to think a long the lines of 'the sooner the better' and while it's still repairable and before I need replacement. But along with that second opinion, I'll be requesting to see a surgeon.

 

[ejc61]

Beespin,

If it makes you feel better, I was moderate for several years if not longer. I've only been seeing a cardiologist since 2006. I think the fatigue, etc. is more of a concern to me than the regurg which is monitored by testing. I find the cardiologist's response to your "symptoms" curious? I saw the cardiologist every 6 months and the first question out of his mouth was always "has anything changed with regard to your activities" or "are you feeling any changes"? While this was going on, it was important to get my weight down which I did and to stay active which I do with cycling, walking, skiing, etc. I think having anxiety contributes to how you feel. I had these panic attacks and had to be talked "off the ledge" on a few occasions. I would probably think about finding a cardiologist associated with a reputable heart center if not already.

 

[catwoman]

Beespin:

In retrospect, I had symptoms for at least 6-7 years pre-op and attributed them to other things: doing too much the weekend before, aging, not getting enough sleep. I knew I had MVR but was NOT under a cardiologist's care. I had been told in 1990 that MVR is very common, and that most never need surgery. Other than taking amoxi before dentals, I pretty much dismissed it from my mind.

Do some research -- find out what the largest cardio practices are in your area and go to those websites. Check out each doctor's profile. See if there's one who has a special interest in valvular disease. That's just one way to find a cardio for a 2nd opinion and perhaps one you can transfer to.
That's how I would start in finding a new doctor. It's also a great way to find a surgeon, other than other people's recommendations.

Is there a teaching hospital in your area?

Good luck!

I had days when I called in sick because I was too tired to go to work. My veins throbbed in my neck -- I thought it was stress. When I was too tired in the middle of a vacation week to get out of bed, I knew something was really wrong.

What I have learned is that many cardios will dismiss complaints from women with MVR/MVP, saying the "numbers" don't warrant further testing or surgery. That the symptoms are anxiety-related. Maybe so, maybe not. But when they start affecting your quality of life, that's a big signal that SOMETHING is wrong.

One term in the report you posted describes the MV leaflets as being "shaggy looking." What the heck does that mean??? Demand a clarification/explanation. That doesn't seem to be a medical term.

 

[Duff Man]

regarding the children issue, I think if you're planning on implanting a mechanical valve when the time comes then your cardiologist is probably correct. It is difficult to have children with a mechanical valve - but a few people have done it. The way I understand it, warfarin causes facial deformities in the fetus and especially at certain periods of gestation... so a substitute called Lovenox or low molecular weight heparin is used during that risky period. I don't think LMWH is the best anti-coagulant for mechanical valves and it seems like the pregnant women with the mechanical valve are at high risk for embolism even with it on board.

As far as your symptoms are concerned, you probably know by now that you should get a second and/or third opinion. I no longer accept anxiety as a reason or cause for my complaints, and you shouldn't either. After being blown off so many times and finally coming across the answer for my problem, it is deeply offensive to me when anxiety is suggested as a source and I will fire someone on the spot for suggesting it. I believe anxiety is a symptom, and the medical community is just beginning to catch on.

 

[cherylchapa]

Duff - I love your moxie! The next time I bite my lip when I should be speaking up (not just in medical situations) I'm going to think, "What would the Duff Man say?"

 

[Jkm7]

In addition to Duff's excellent post is that a woman with a tissue valve can almost always have successful pregnancy. A tissue valve (usally) will not require ACT. You should definitely discuss that with your Cardio and Ob /Gyn. A pregnancy with a tissue valve is safe for most.

Best Wishes.

 

[Luana]

Either have children before the VR, or if that's not possible, then get a tissue valve. The only woman I've ever heard of to have a child with a mechanical valve is a woman who had a surrogate.

 

[Lynlw]

In addition to Duff's excellent post is that a woman with a tissue valve can almost always have successful pregnancy. A tissue valve (usally) will not require ACT. You should definitely discuss that with your Cardio and Ob /Gyn. A pregnancy with a tissue valve is safe for most.

Best Wishes.

Also since you have Mitral valve problems, if they were able to repair and not replace the valve, you "shouldn't" have any problems for you OR the baby with pregnancy..

Also since it is a Mitral valve, I believe, IF you did have a mech valve the risks of clotting during the pregnancy or delivery are even higher than someone with a mech Aortic valve.

I know you mentioned getting other opinions, but if all your Cardiologist said about having children was "to have children NOW (if they were in my future), since after surgery I couldnt even consider a pregnancy" and she didn't explain the reason or all the options or differences, that would make me even more motivated to find a good cardiologist.

 

[dick0236]

After that Summary, there is a list of measurements and calculations that are extremely confusing. The only measurement that is 'familiar' reads:
MR max vel: 420 cm/s

After my visit, the cardio couldnt tell me if I would be looking at repair or replacement in my future. She did, however, make it clear that I could at anytime experience Congenital Heart Failure which could lead to pretty immediate surgery. With that being said, she advised me to have children NOW (if they were in my future), since after surgery I couldnt even consider a pregnancy. Let me know what you think, and if you're able to explain any of the findings, I would appreciate that as well. Thanks again everyone.

I can understand your confusion....that's why we pay these docs BIG BUCKS. My advice is find a doc that you trust and believe in and then take his/her advice. Don't ask and internet forum to medically interpret test results.

I just went to my new cardio yesterday. This time I chose one who is 78 years old... three years my senior. I did that because he was practicing medicine when I got my valve. Pretty much all of my old medical records have been lost or destroyed, but an old "operating room record" mentioned that I had a "gradiant of 117mm over the Aortic valve". I asked him how serious that was......He said it was "critical, and that I had been give the right valve at the right time". During a consultation, prior to my 1967 surgery, the Cardiologists told me I was a candidate for "sudden death" and would not live to age 40 without corrective surgery. Since I have lived a lot longer than really expected, I agree with him. Forums like this are very good support groups.....but make very poor cardiologists:wink2::biggrin2:.

 

[dick0236]

PS: I learned something else from him. My blood pressure normally runs 140 to 155 over 75 or 85. He told me, that with my valve, those numbers were very good. He said the "normal reading of 120" would be of more concern than 140 or 155. It's amazing what you can learn when a doc will take the time for a little conversation.

 

[Nupur]

Why does your cardio think you can go into CHF? You don't go into CHF until your heart starts enlarging and yours is not. I have moderate - severe regurgitation but heart size is fine and I was never told I could go into CHF any time.

Regarding the anatomy of the mitral valve, anterior leaflet is harder to repair than the posterior leaflet. After my TEE, the cardio thought it would be hard to repair my valve when the time comes. Dr Miller didn't think so. Only a surgeon can say what your chances are of a repair.

Pregnancy is a big strain on your heart, so if you are planning to have children before surgery, with moderate regurgitation already present, you will likely need surgery soon afterwards.

Definitely get a second opinion. Good luck!

 

[jennifer]

beespin,
I understand your concerns, especially if you are considering pregnancy. A helpful site that I have posted on here several times is http://www.echopedia.org/wiki/Normal_Values. Actually, your echo results look better than mine did before I had five healthy pregnancy/deliveries. (Didn't plan on five, but had vasectomy failure after three. That's a story for another day... . I had at least moderate AR and mild MR, with mild/moderate LV dilation. I was, and for the most part continue to be, asymptomatic and on no medications. My EF was the same as yours, but I did find out that my cardiologist had labeled me with 'CHF' because I tried to increase my life insurance and they listed that on their refusal letter. I now have AVR and repair of aneurysm scheduled for May 9th and have chosen a tissue valve because my youngest child is 7 and I want to be as active as possible while they are all at home with me. I hope that you never need surgery, but I'd just encourage you to advocate for yourself and make the decision that's best for you and your family.